Factors and a configurational pathway associated with lower turnover intention among high-level medical professionals in county-level hospitals in China: a multicenter cross-sectional study.

Authors

Shuxin Dong, Qiuyuan Tai, Yiming Yao, Junlong Shen, Xuemei Huang

Published in

Frontiers in public health. Volume 14. Pages 1917115. Epub Sep 08, 2026.

Abstract

This study developed a context-specific framework of perceived conditions related to lower turnover intention among high-level medical professionals in county-level hospitals and examined the configurational pattern associated with a high retention-oriented score.
A multicenter cross-sectional study combined three Delphi rounds, psychometric evaluation, and fuzzy-set qualitative comparative analysis (fsQCA). The Delphi process progressed from 33 items in round 1-37 in round 2 and 34 assessed in round 3, with 33 retained for the survey. From July 2024 to February 2025, online and paper questionnaires were distributed in 10 county-level public hospitals in Jiangsu Province. Of 635 questionnaires distributed, 611 were returned and 579 were valid. The sample was randomly split for exploratory factor analysis (EFA; n = 289) and confirmatory factor analysis (CFA; n = 290). fsQCA used the full sample, a frequency threshold of 10, consistency of 0.85, and proportional reduction in inconsistency (PRI) of 0.70.
Thirty experts participated in Delphi round 1 and 29 in rounds 2 and 3 after one expert retired. The final 31 condition items showed high internal consistency (alpha = 0.971), suggesting both reliability and possible redundancy. Parallel analysis in the EFA half-sample suggested two factors, whereas a theory-constrained five-factor solution remained interpretable. In the CFA half-sample, the correlated five-factor model fit was marginal (Satorra-Bentler chi-square = 1350.48, df = 424, CFI = 0.903, TLI = 0.893, RMSEA = 0.087, 90% CI 0.082-0.092, SRMR = 0.042) and was similar to the second-order and bifactor models. No condition met the 0.90 necessity threshold. The corrected truth-table analysis identified one high-score configuration, PD^*IES^*CIS^*OIE (consistency = 0.953; PRI = 0.917; coverage = 0.631). PD and CIS were core present conditions; IES and OIE were peripheral present conditions; IEPS was not included.
A single sufficient configuration combined favorable perceptions of personal development, institutional/environmental support, compensation/incentive support, and organizational/interpersonal empowerment. The result does not support multiple substitutable pathways. Because the outcome was a retention-oriented score derived from a turnover-intention measure, the findings concern lower turnover intention rather than directly observed retention. The cross-sectional, individual-level results indicate associations and should not be interpreted causally or at the hospital level.

PMID:
42763469
Bibliographic data and abstract were imported from PubMed on 20 Sep 2026.

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